Editorial: Medicaid key in inmate rehabilitation

Last modified: 3/22/2015 12:55:05 AM
The House Finance Committee chambers is once again an abattoir for numbers. State programs present there to be sacrificed on the altar of small government or become subject to experimental surgery. How much flesh and bone can be removed and the patient still survive?

One program destined for the cutting room floor under Republicans is the state’s expanded Medicaid program. It provides health insurance for some 36,000 people who otherwise would not have it, since the state’s standard Medicaid program does not cover adults unless they are disabled. The program costs the state virtually nothing, since the federal government is picking up 100 percent of the tab until 2017. That share diminishes gradually before leveling off at 90 percent federal support in 2020.

Unless the current Legislature reauthorizes the expanded program, it will die and tens of thousands of residents will lose coverage. A growing number of them will be inmates released from prison, the group we’ll focus on today.

Voters should know that while the program will cost the state’s taxpayers some money in coming years, the expense will be more than offset by reduced hospital costs, insurance premium rates and the added boost to the state’s economy by the large and steady infusion of federal money – $800 million in the current biennium – that provides high-paying jobs. But the savings is even more dramatic, and the impact on society even more profound, when former inmates are insured.

An estimated 80 to 90 percent of all prison inmates have a substance abuse problem, mental illness or both. About 90 percent of those inmates will re-enter society, which comes to about 140 per day in New Hampshire. Until recently, as one corrections official put it, a prison worker would take an inmate due for release to the gate, open it and say: “We’ve done all we can for you given our limited resources. There’s the cliff. Jump.”

A bit more than half survive. The rest, their illness or addiction untreated, are soon behind bars at public expense again. And that’s not the only cost. There’s the hefty price of hospital care, mostly in emergency rooms, that goes unpaid; the loss when a citizen is a financial liability rather than a taxpayer; the added costs for law enforcement and crime – all those smashed car windows, burgled homes, shoplifted goods, robbed stores, state hospital bills and trauma for the victims of crimes that might have been avoided.

Most inmates released from prison today are handed a Medicaid card that allows them to pay for mental health counseling, medication, substance abuse treatment and basic health care. The recidivism rate for those who avail themselves of those services, and parole officers insist that they do, is much lower than for inmates cast adrift.

In 2013, the Lewin Group, a consulting firm hired by the state to analyze the impact of Medicaid expansion, estimated that the savings for New Hampshire’s corrections system alone would amount to just short of $22 million between 2014 and 2020 if Medicaid expansion continues. The health care system, businesses and law enforcement will also save, which is why they want the program to continue.

New Hampshire’s corrections system has never had – and, barring more lawsuits and court settlements, probably never will be given – the resources necessary to truly treat and rehabilitate inmates before returning them to society. That is, of course, its mission – that and doing all it can to support crime victims by reducing the likelihood that they will be victimized again.

Expanded Medicaid allows the system to come closer to fulfilling that mission and protects the public while saving taxpayers money. Voters should contact their representatives and senators and tell them they want the program to continued.




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